A 63-year-old man with
Eaton-Lambert syndrome manifested by marked
respiratory failure was reported. He began to notice
blepharoptosis and
diplopia in September, 1987, followed by weakness and easy fatigability in bulbar, neck and limb muscles in association with
impotence by February, 1988. On admission in August, 1988, Gowers' sign, decreased tendon reflexes and
muscle weakness improved by the injection of
edrophonium were found. Anti-
acetylcholine receptor antibody was negative. Single muscle action potential evoked in the thenar muscle was abnormally low in amplitude with the stimulation of the median nerve: repetitive nerve stimulation study revealed the waning at the low rates, but the waxing at the high rate (30 Hz), suggesting the diagnosis of
Eaton-Lambert syndrome. Early
gastric cancer (
adenocarcinoma) was diagnosed from needle biopsy specimens in August, 1988, but no other
neoplasm including
thymoma or
lung cancer was found. After subtotal gastric resection in September, 1988, he failed into
respiratory failure, requiring artificial ventilation for seven months.
Plasmapheresis and drugs such as
anticholinesterase,
guanidine hydrochloride, and
corticosteroid were ineffective for the recovery from weakness in respiratory muscle.
Lung cancer was suspected, based on a chest X-ray in March, 1989, and one month later he died of
pneumonia. At autopsy,
small cell carcinoma of the lung was observed, but there was neither recurrence nor
metastasis of the
gastric cancer. Emphasis was placed on the
respiratory failure in
Eaton-Lambert syndrome which has rarely been reported.